ENDO terminology Flashcards
When should you consider a non odontogenic source?
if no identifiable cause, history of clinical findings are inconsistent with odontogenic pain
spontaneous pain with a hx of previous pain in the same tooth usually indicate what?
presence of severe and irreversible pulpitis
If patient has been “delaying the treatment for a few year”- typically NOT an endo issue???
T/F
Odontogenic pain often crosses the midline?
FALSE!!! very rarely
why might you wait to localize the tooth?
when the inflammation goes to the PDL, usually the patient will feel this upon percussion
30% of patients in the beginning stages cannot localize pain
T/F?
true
If you cannot localize the pain, and have been following the patient for a month, what do yo think the cause of??
not endo
These issues can be less than 10%
Periodical disease of endodontic origin is mediated by ____
bacteria
what are the two components of an endo diagnosis?
pulpal and periapical
is condensing osteotis periodical or pulpal?
periapical
give an example of an endo diagnosis?
8 pulp necrosis with asymptomatic apical periodontist
REMEMBER, it needs the two components
How long does a “normal” cold/heat response last?
3-10 seconds is “normal” but it also depends on what is NORMAL to the patient
Find a control somewhere in the mouth. Compare the tooth in question to the control
Describe reversible pulpitis?
this means that subjective and objective findings indicate that inflammation is present, but should resolve WITHOUT a root canal.
You keep the tooth alive in this scenario, but there is something you need to work on
what might cause reversible pulpitis?
hx of a recent restoration (usually an amalgam, composite, or crown prep) within several days to a few weeks
- Often a first time complaint!
- symptoms resolve quickly after the stimulus is removed
- NO RADIOGRAPHIC CHANGES YET
If patient just had a big filling a few days ago- tell patient to wait about 2 weeks because that’s normal and expected to be heat sensitive or sensitive in general Test the same day though to establish a baseline, wait two weeks, and then see if anything has changed.
Describe irreversible pulpitis:
Symptomatic and asymptomatic.
The reality is that the pulp is INFLAMMED, but cannot be fixed with conservative therapy.
Symptomatic usually comes with LINGERING thermal pain, spontaneous, and referred pain. Does it start on it’s own? How long does it last?
Asymptomatic- there are no clinical SYMPTOMS, but inflammation typically produced by caries, excavation, or trauma
In an adult, a carious pulp exposure likely leads to what?
endo treatment in the very near future
Why is irreversible pulpits difficult for students to figure out?
it’s difficult to localize!!!!! often presents with NO symptoms, or a LARGE range of symptoms
T/F
Irreversible pulpitis will always respond to EPT/COLD?
TRUE!!!
symptomatic will have an ABNORMAL response, and ASYMPTOMATIC will have NORMAL!!!!
radiograph generally reveals widened PDL, or it can be WNL
T/F
EPT and COLD test blood supply?
false!!! just the nerve
when you are doing an EPT test, what are you looking for???
The numbers DON’T MEAN ANYTHING!!! Basically- if it doesn’t react AT ALL, then that’s NO BUENO. EPT is like a pregnancy test- NO DEGREES!!!
The numbers are just the strength of the current
If you have a lot of sclerotic dentin or tertiary dentin, how does this effect EPT?
yes, still works
what is the more accurate test? EPT or COLD test?
cold…
why might you have a false negative with cold test?
calcified canal.
Anytime a tooth doesn’t respond to the cold test, you have to do a follow up….
If your tooth responds poorly to pain, with lingering pain with cold test, do you need to EPT test?
no, because you know it’s already inflamed and compromised
If patient has a crown, and didn’t respond to cold, what might you do?
percussion
Why are we “guessing” at all times with our endo tests?
we can never test blood supply WHICH means you are purely SPECULATING about the true histological diagnosis. You have to look at chief complaint, radiographic, clinical assessment and see if adds up to a straight forward diagnosis
If caries is in the pulp, where are you automatically?
irreversible.
It could be necrotic though
T/F
Necrotic often have a worse chance of healing?
true???
Asymptomatic irreversible pulpitis
decay is encroaching on the pulp but patient responds normally? Caries exposure would result in PULP EXPOSURE
When you evaluate the extent of decay, what radiographs should you have?
BITEWINGS ALWAYS!!!!!
T/F
Irreversible pulpits may refer pain to the opposing arch?
true!
it could be to adjacent areas! So it won’t cross the midline, but it can refer and cross arches, but NOT THE MIDLINE!!!!
what type of endo has the highest incidence of referred pain?
IP
pts often taking analgesic
IP
If patient is a pill popper, think about IP. Ask when they took the last dose when you are trying to diagnose. IBUPROFEN might interfere and mask.
Narcotics and tylenol will NOT have that…but Ibuprofen and antifilammatories can skew the results.
Is blood supply or nerve supply lost faster???
BLOOD SUPPLY LOST MUCH FASTER than nerve supply.
previously treated vs. previously initiated?
previously initiated means they may have started but didn’t finish
If a tooth has been previously endo treated, can you now say that it has normal apical tissues?
yes, this works for previously treated teeth as long as the lamina dura is intact and PDL space is normal
teeth with biting or percussion/palpation sensitivity
symptomatic apical periodontitis
Radiolucent lesion may or MAY NOT be present
describe Asymptomatic apical periodontis?
infalmmation and destruction of the apical peridontium that is of PULPAL origin!!!!
Appears as apical radiolucent area but NO clinical symptoms!!!!
Describe an acute apical abscess?
SWELLING!!! that’s means AAA…
Immune response typically in first 42-78 hours…NOT a chronic issue here. You can have an acute exacerbation of a chronic problem but you would still classify this as ACUTE
if you have an acute exacerbation of a chronic problem, do you classify this as chronic or acute?
acute…this is what will dictate your treatment
If you have acute apical abscess, is tooth usually vital or necrotic?
at this point, usually necrosis and infection
Describe chronic apical abscess?
they are typically gradual onset with little or no discomfort. Intermittent discharge of pus through a sinus tract
BIGGIE is the draining SINUS tract…
